electrical inspection RX Date/Time 12/06/2019 13:08 15182731202 P,002
».Dec. 6, 2019 <12, -�'MLMDIA No, 2010 P, 2/6
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MIDDLE DEPARTMENT INSPECTION A,GENCY, INC.
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�,�.�� �tea that the electrical wiring to the electrical equipment listed below has been examined and is approved as
;`"�j, being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date /fig\
noted below and is issued subject to the following conditions. ,
,� Owner: Date: �i
j Steve Brayton 11/26/2019 Pl
* Occupant_ Pool&Shed Location
16 Honey Hollow Road
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Occupancy' Queensbury, Warren Co. NY )
.., Swimming Pool
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'-� Applicant: ca (3
ii Derricks Home Services LLC 7 t l Tv ��
64 Sa674
gamore St. '"`� J
�`�Glens Falls, NY 12801 .. . • LI .•
D'"C 0 6 2019 )
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a, li. i I
, Joseph A.Holmes - ----�
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1
144017113267EL `. 01---- - k - 2\ Fb)
0' Equipment:
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1 - 100 Amp. Sub Panel; 4- Switches; 5-Receptacles; 3- Fixtures;1 - Pool Pump; 1 -50 Amp Pool Heater; 1 -Time
Clock C
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1. This certificate applies to the electnesl wiring to the electrical equipment listed immediately null and void. This certificate applies only to the use.occupancy end
>� above and the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership g�)
inspection. No warranty is expressed or implied as to the mechanical safety,effi- of the property indicated above,this certificate shall be Immediately null and void. 0
'p ciency or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes Invalid based upon the above conditions. Y
be valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspection by Middle Department y
i system to which this certificate applies De altered in any way,including but not limit- Inspection Agency,Inc. An application for inspection must be submitted to Middle `&
ed to,the Introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc, to initiate the inspection and revalidation `1
'`e- any of the components Installed as of the above noted date,this certificate shall be process. A fee will be charged for this service.
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